What is Mentalisation-Based Therapy?

Last reviewed by

Dr. Sheri Jacobson March 14, 2023

Often second guess yourself? Spend a lot of time worrying what people think about you, or if they like you at all? Or sometimes get accused of overreacting or overthinking things? Mentalisation-based therapy might be for you.

What is mentalisation-based therapy?

Mentalisation-based therapy is a psychotherapy focussed on helping you have clearer and more correct thoughts about yourself and others. The idea is that if you improve your thinking, you will gain control over problematic behaviours and make better choices, meaning your relationships improve and you feel better.

A medium to long-term therapy, mentalisation-based treatment, or ‘MBT’, is often offered in a mix of individual and group sessions, or can be used as a form of family therapy .

And what is ‘mentalising’, anyway?

Peter Fonagy, the psychoanalyst who made a therapy out of the concept, describes mentalising as, “The process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes.”

An easier way to see it is as, ‘thinking about thinking’. We all do this when we ask ourselves, “What do I think about this?’. “What do they think about me?”. It’s powerful stuff, because we base our beliefs, choices, and actions on the answers.

By: brittany

We are all occasionally bad at mentalising. A classic example is being in love. We wear the proverbial ‘rose coloured glasses’, and we make big assumptions about ourselves and the object of our affection.

Some of us, due to the ways we were raised or things we experienced, are actually never good at ‘mentalising’, particularly when it comes to relationships. We might think we are good at it, but we actually have minds that:

assume the worst
go in circles
panic and make impulsive decisions
that upset others and leaves us feeling lonely and rejected.

An example of good vs bad mentalising

Let’s take the classic ‘he didn’t call when he said he would’ scenario.

If you are good at mentalising, you might think that his phone battery ran out, or that he has a perfectly good reason you’ll wait to hear about. You are sure you like him, so there is no use getting upset just yet. You feel fine, and take no major action but to wait a few more hours and see.

If you are bad at mentalising, you will assume that he must not like you, he’s trying to avoid you, maybe he’s even out with someone else and is going to break up with you. Then you start to doubt your own thoughts. Do you even like him as much as you thought? Do you want to be in a relationship? You suddenly feel terrified, angry. And impulsively leave a text you think it’s time to put the brakes on.

Why am I no good at mentalising?

Again, it’s connected to childhood. Fonagy explains that,

“When we are infants, we exist in a state of physical arousal, and learn how to think from our caregivers.” If our parent or caregiver can’t effectively ‘mirror’ how we feel, we don’t learn to organise our own feelings.

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For example, if we are anxious as an infant, our mother sees we are anxious. If she mirrors back a similar level of anxiety, we can organise in our mind what it is. But if she reflects back disinterest, we might learn to ignore our own worries. And if she reflects back terror at our mild anxiety, we might learn to overreact to any anxiety we have and carry that pattern into adults, so that we are out of touch with our own feelings.

And then childhood trauma can interrupt our mentalising. If we are abused, or threatened with abandonment, we might no learn we can’t trust anything, including our own thoughts and feelings.

Our ability to mentalise can be further eroded if we are in a family that isn’t concerned with how we think and feel. A healthy family, on the other hand, helps a child be resilient by caring about their beliefs, desires, and needs.

MBT and borderline personality disorder

Mentalisation-based treatment was originally developed to treat borderline personality disorder (BPD).

If you suffer from BPD, you often have dramatic thinking centred on black and white thoughts. You assume your thoughts are real, particularly when they are around whether people might reject or abandon you. And you then have extreme, out-of-control emotions to match, leading to impulsive decisions or saying harmful things to those you love.

An overview of research studies around BPD and mentalisation-based therapy found that MBT reduced BPD-specific symptoms like interpersonal issues and suicidal behaviour, as well as helped with the depression and anxiety many BPD sufferers also deal with.

What other issues can MBT treatment help with?

As well as borderline personality disorder, mentalisation-based therapy is thought helpful for the following:

anger issues
anorexia nervosa and other eating disorders
attachment disorders
depression
emotional dysregulation
other personality disorders
trauma
trust issues
relationship problems
self-harm
substance abuse.

What is a mentalisation-based therapy session like?

Your first few sessions are an assessment. Your therapist aims to understand what bought you to therapy, and what you hope to gain from it. What difficulties are you currently facing? How might they have originated, what past experiences might have been involved, and what might keep triggering them?

From there your sessions will involve helping you with your present day struggles and relationships. This can mean asking questions like: